Provider Demographics
NPI:1437197266
Name:JACOB, FELICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 N HIAWASSEE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3003
Mailing Address - Country:US
Mailing Address - Phone:407-906-0082
Mailing Address - Fax:407-604-2606
Practice Address - Street 1:2724 N HIAWASSEE RD STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3003
Practice Address - Country:US
Practice Address - Phone:407-906-0082
Practice Address - Fax:407-604-2606
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274296900Medicaid
FL30968YOtherMEDICARE
FLLL590OtherMEDICARE